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TOWN OF YARMOUTH ��
� SEWAGE PLAN REVIEW CHECKLIST ��,�y � ��� ` `�� / "�
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` Location: A.M.� Lot �Z Zone of Contribution: In �ut_ Acreage �'((j�2 ��
Commercial: Residential: ✓
Street: �' S .r'/
Village: Floor Plan: � #Bedrooms:_�
Owner: ` lG� '%��y�� Insta.11er:
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Address: Phone:
' Phone:
Builder: ? Engineer: �i � �
Address: Phone: l���' -- � ``�,C,�/
Phone: �-�;� �,���, ��- � ��r✓ /�
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N/ O
1.Re uired#of co ies received
2.Date of soils exam and ercolation test not older than 2 years ���"
3.4-5 ft of naturall occunin ervious material, above water table
4.Foundation 2 ft above high oint of road H.P.: Fnd: Var.: `
5.Water line 10 ft from s tic com onents Var.: �-/'
6.Benchmark indicated and shown-NGVD if neax wetlands ���"
7. Se tic tank minimum 10 ft from founda.tion, deck Var.:
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leaching minimum 100 ft from wetlands Var.:
10.Leaching minimum 150 ft from drinking welU25 ft irri tion well Var.: .
11.Tank/leaching minimum 10 ft from ro erty line Var.: �.�
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum hi groundwater V •
14.Leaching set 4-5 ft above ad'.water or botto of tesf hole� .: �
15. System not in to or subsoil(A,B horizons)o 'removal �/
16.Pro osed contours are suitable 1�.--^
17. S stem meets slo e r irements-min. 1/8", 1/4" referred '
18. S stem meets breakout re uirements PVC liner: Wall:
19. S ecified tee sizes are ro er, as baffle on outlet tee ,��
20. Sewage is under 10,000 gpd for arcel l./
21.No garbage dis osal �-�'
' 22. S stem ad uatel sized for its intended use L.---�'
23.Minimum 6"stone or com acted below tank and dbox �._..-.
24.Ma.nhole covers within 6"of grade,pum cha.mber cover to grade -
- 25.Inspection ort on lastic chambers/leach field u
26.Electrical ermit for um chamber/S arate meter for du lexes -
27.Pum system-2" line,wee hole,check valve,tee in dbox,pum size
28. S tic tank/pum chamber to be facto wa roofed �.-
29.Vent rovided if leachin below 3 feet,under driveway/parkin ✓i
30.Buoyancy calculations for tank/pump chamber �-�
31.En ' eer to ins ect and cert' soils: wall: commerciaL• � ��
32.En 'neer/Registered Sanitaxian and Land Surveyor stam s/si ture
33.H-201oading is sub'ect to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer signature
35.Foundation footing min. 2 feet above ad'usted ground water for new house ��-
36.Deed Restriction r uired maaL. #bedrooms: "�ax. flow: -7i�� d
37.Check area lots for oundwater/Label groundwater in Assessor's Ma
Plan reviewed by: � �03�03 '